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Radiation Enteritis

Last updated Jan. 10, 2019

Approved by: Maulik P. Purohit MD, MPH

Radiation Enteritis is a medical condition which is characterized by damage to the lining of the intestine.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Post Radiation Enteritis
  • Radiation Enteropathy
  • Radiation-Induced Bowel Injury

What is Radiation Enteritis? (Definition/Background Information)

  • Radiation Enteritis is a medical condition which is characterized by damage to the lining of the intestine. In this condition, there is damage of both the intestinal cells and tissues
  • A complication occurs as a result of undergoing radiation therapy, which is one of the common and frequently used methods for cancer treatment. Radiation therapy uses high energy particles or waves, such as x-rays or proton beams, to kill the cancer cells by damaging their DNA
  • Any individual who undergoes radiation therapy for cancer of the abdominal organs is at risk for Radiation Enteritis. This includes those with cervical, pancreatic, prostate, uterine, colon, and rectal cancers
  • The condition is mainly characterized by the onset of diarrhea which may contain blood, nausea, weight loss, and abdominal pain
  • There is no definitive treatment for Radiation Enteritis; it mainly depends on treating the symptoms and modifying one’s lifestyle suitably

Who gets Radiation Enteritis? (Age and Sex Distribution)

  • Any individual, who undergoes radiation therapy to the belly, stomach, or pelvic area for cancer, can be affected by Radiation Enteritis
  • Generally, older individuals are more at risk of this condition
  • There is no distinct gender, racial, ethnic, or geographic predilection observed

What are the Risk Factors for Radiation Enteritis? (Predisposing Factors)

Individuals receiving radiation therapy to the abdominal or pelvic region are at risk for Radiation Enteritis. The risk factors may include:

  • Advanced age of the individual undergoing radiation therapy for cancer
  • Higher dose of the radiation used
  • Previous abdominal surgery that could have caused adhesions in the abdomen; this leads to attachment of some portions of the small and large intestines to the radiated field
  • History of pelvic inflammatory disease
  • Hypertension
  • Diabetes mellitus
  • Individuals who typically have a slim or thin physique
  • Individuals undergoing chemotherapy treatment

The presence of other medical conditions such as the following is also linked to Radiation Enteritis:

  • Collagen vascular disease: It is a condition that affects the connective tissue. Collagen is a protein-based connective tissue that gives support to the skin
  • Xeroderma pigmentosum: It is an inherited condition characterized by extreme sensitivity to ultraviolet rays from the sun
  • Cockayne syndrome: It is a rare disorder that is characterized by short stature and premature aging

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Radiation Enteritis? (Etiology)

  • Radiation therapy is commonly used to treat cancer and it employs the use of high-energy particles or waves, such as x-rays, gamma rays, electron or proton beams, to destroy cancer cells by damaging their DNA
  • Intestinal lining cells, which are very sensitive to radiation treatment, are damaged and slough off during treatment. The exact cause of how radiation affects the intestines, which leads to Radiation Enteritis is being researched into currently

Individuals with the following cancers receiving radiation therapy may be affected by Radiation Enteritis:

  • Cervical cancer
  • Pancreatic cancer
  • Prostate cancer
  • Uterine cancer
  • Colon and rectal cancer

What are the Signs and Symptoms of Radiation Enteritis?

The signs and symptoms of Radiation Enteritis depend on what part of the intestine received the radiation. The symptoms may be acute (occurring immediately following radiation therapy) or chronic (symptoms that appear long after the treatment has stopped and which also persist for a long period).

Acute symptoms of Radiation Enteritis include:

  • Changes in bowel movements that include:
    • Bleeding from the rectum
    • Diarrhea or watery stools
    • Constant feeling of a need for bowel movement
    • Pain in the rectal area, especially during bowel movement            
  • Nausea
  • Vomiting, diarrhea
  • Anorexia, loss of appetite
  • Fever

Chronic symptoms of Radiation Enteritis include:

  • Abdominal pain
  • Diarrhea accompanied by blood
  • Greasy or fatty stools
  • Loss of weight

How is Radiation Enteritis Diagnosed?

The diagnosis of Radiation Enteritis may involve:

  • A thorough physical examination correlated with a complete medical history (including family and social history)
  • Barium x-ray test: Radiographic examination of the gastrointestinal tract to check for abnormalities such as tumors, ulcers, and other inflammatory conditions within the GI tract
  • Sigmoidoscopy/colonoscopy test: A test that is used to look into the interior lining of the intestines using an instrument called sigmoidoscope/colonoscope (a thin flexible tube). It may be necessary to diagnose and to treat associated bleeding
  • Upper endoscopy test: Examination of the upper portion of the gastrointestinal tract with the help of a flexible tube
  • Other imaging studies may include:
    • Plain abdominal radiograph
    • CT scan of the abdomen and pelvis         
  • Selenium -75 homocholic acid taurine (SeHCAT) test
  • A bowel wall biopsy may be performed to differentiate between Radiation Enteritis and other cancers

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Radiation Enteritis?

Complications due to Radiation Enteritis can include:

  • Anemia due to blood loss: It is a condition in which blood has lesser than normal level of red blood cells
  • Dehydration, caused by diarrhea
  • Iron deficiency: A condition marked by too little iron in the body
  • Malabsorption: A condition characterized by the inability of the body to fully absorb nutrients from the gastrointestinal tract
  • Malnutrition: A condition that occurs when the body does not get sufficient nutrients
  • Weight loss

How is Radiation Enteritis Treated?

The treatment measures for Radiation Enteritis may include:

  • A low-fiber diet needs to be followed when radiation therapy commences
  • The choice of foods should be decided based on the symptoms exhibited
  • Avoiding the following food items may be helpful:
    • Alcohol, tobacco, almost all milk products, coffee, tea, chocolate, soda and caffeine, whole bran, fresh fruits, dried fruits, fried foods, fatty  and greasy foods, nuts, seeds, raw vegetables, popcorn, potato chips, pastries, baked foods, certain fruit juices, and strong spices
  • Consuming the following food items is recommended:
    • Apple and grape juices, apple sauce, peeled apples, bananas, eggs, buttermilk, yogurt, fish, poultry, broiled or roasted meat, mildly cooked vegetables, baked or boiled potatoes, processed  cheese, peanut butter, white bread, macaroni, and noodles

Other measures that can be adopted to control the symptoms of Radiation Enteritis may include:

  • Eating food at room temperature
  • Eating small meals frequently daily

Medical therapy for the treatment of Radiation Enteritis may include:

  • Basic bowel care
  • Sulfasalazine (oral medication)
  • Amifostine
  • Sucralfate administered either orally or as an enema
  • Glutamine

The following treatment methods are followed to reduce the signs and symptoms of Radiation Enteritis:

  • Adequate intake of water to maintain hydration levels
  • Antidiarrheal medicines, such as loparamide, to decrease the incidence of diarrhea. When diarrhea is not controlled with the use of loparamide, then octrotide may be prescribed

Other treatment methods may include:

  • Use of bile-sequestering agent cholestyramine, also helps in reducing the frequency of diarrhea
  • Steroid foam - that is used as a coat around the lining of the intestine
  • Special enzymes to replace enzymes lost from the pancreas
  • Chronic radiation effects may not be cured; but the use of medications, such as cholestyramine, diphenoxylate-atropine, loperamide, or sucralfate, can help in reducing the effects of chronic symptoms
  • In rare cases, the physician may recommend a surgery to remove a section of the damaged intestine

How can Radiation Enteritis be Prevented?

There is no definitive prevention for Radiation Enteritis, if radiation treatment is administered as part of cancer therapy. The commonly used preventive methods for reducing symptoms may include:

  • Basic bowel care
  • Dietary modifications such as consuming a low fiber diet

Modification in some of the techniques used in delivering radiation therapy can help decrease the severity of Radiation Enteritis. This can also help reduce the damaging effects of the radiation treatment on the intestinal cells.

What is the Prognosis of Radiation Enteritis? (Outcomes/Resolutions)

  • The prognosis for Radiation Enteritis is very good when the symptoms are acute. In most of the cases, the symptoms improve within 2-3 months after radiation therapy is completed
  • Chronic Radiation Enteritis is difficult to treat and is rarely curable

Additional and Relevant Useful Information for Radiation Enteritis:

  • A research was conducted on the incidence of chronic Radiation Enteritis in more than 100 women who had undergone radiotherapy for cervical or endometrial cancer

    • The aim of the investigation was to determine if the radiation level or the stage of the cancer increase the risk for the occurrence of Radiation Enteritis
    • The investigation brought forward the fact that chronic Radiation Enteritis was most prevalent among younger women and among patients, who had undergone treatment for cervical cancer     

  • Almost all patients who receive more than 150 rad per day are likely to develop acute Radiation Enteritis. It may develop while undergoing the therapy or immediately after completion of the treatment
  • A radiation dose of more than 5000 rad may result in the development of severe chronic Radiation Enteritis

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: April 23, 2015
Last updated: Jan. 10, 2019